How the maternity hospital is arranged. How to choose a maternity hospital

Very frequently discussed question of the type of maternity hospital for what come up with?
I did not find about the hospital in Europe, but in Russia it was definitely an institution for those who were not going to leave children.
Yes, and in pre-revolutionary Russia, the percentage of births at home was big.

History of the emergence of maternity houses

The first maternity hospital (and the maternity hospital) in Moscow (and in Russia) was opened in 1764 at an educational house and had three branches: "For secretly related", "for born illegal children" and "for women married, but not wanting to leave a child" . In 1801, Professor of Moscow University V. M. Richter (1767-1822) founded and headed the rebeling institute with a maternity hospital for 3 beds. The first city maternity shelter with free reception of the feminine was created in 1880 on the Schwiest Gorka. In 1903 in Moscow there were 12 maternity homes (at 138 beds). In 1906, a "exemplary" maternity hospital has been opened. A. A. Apricosova (now the maternity hospital number 6), in which women's and children's consultations were created. In 1907, a maternity hospital (63 beds) was opened at the merchant to the merchant of Lepøhin, who was his name (subsequently the maternity hospital number 7. G. L. Grewerman). In 1907, the first hospital for postpartum patients was opened in Moscow. In 1909, an urban maternity hospital in memory of S. T. Morozova opened in the old-skaterinin hospital. At the funds of the late Lepheryna, his niece Milyukova arranged in the Degtyar alley of the hospital, in which the maternity hospital was later located, and the lane was called Lephechinsky.

Until 1917, the maternity hospitals of the city could take only about half of the feminine (the rest of the house). A significant increase in the network of maternity homes occurred after the decision of the CEC and SCA of the USSR on the prohibition of abortions (1936) and in 1960-85.

Snigire history is indicative in this sense until 1917
i will give a quote

During this period, 168 overwhelming butts were trained in the walls of the institute, which, after the end of special training, were sent to various provisions. In 1833, the maternity hospital and the rebeling institute were combined into one born institution. Since that time, it became known as the St. Petersburg Ring History.
Anniversual institution then consisted of 5 compartments for: 1) "legitimate" poor godlings; 2) "secret" maternity hospitals; 3) "illegal" godlings; 4) overwhelmed pupils (for 40 people); 5) peasant student (for 20 people).
The term of study in the obedional institute was reduced to 2 years.
The situation of this institution, which envisaged, were formulated in the position of the entry institution.
the reception of pregnant and feminines as "legitimate" and "illegal", which is delivered without any full-time fee, all kinds of obstetric and medical allowance to their perfect recovery;
supplying state with knowledgeable and experienced earliest grandmas, which receive upbringing and full theoretical and practical education in obequious art;
improvement and distribution of generic science.

As can be seen from all over the above, the homes of the house were common practice and midwives were trained mainly for this.
It would be interesting to read when the practice of childbirth in the hospital became widespread.

It is no secret that the success of childbirth depends largely on how confidently and comfortably feels like a future mother. But most women are worried before childbirth, and for some stress, it becomes arrived in the maternity hospital - after all, this is a completely unfamiliar medical institution. How is the hospital? Let's read the place where our long-awaited kid will appear.

Any maternity hospital begins with a reception office. It is here that a woman comes with fights or with any complication of pregnancy. The future mother coming in the hospital, the first meets the midwife attendant: it will take the exchange card, will offer to convex, and then spends directly into the receiving department. The receiving office usually consists of two isolated receiving chambers from each other: in one they take patients entering the roblock or the pathology department, in the other - those who need to lie down in the observation department (non-ledmed women without a exchange card or those patients who have Any infectious disease). In each of the receiving chambers there is an observation room with an inspection couch and a room for hygienic procedures with a shower and toilet. Here the doctor obstetrician-gynecologist will examine the future mother, will issue her documents, then the midwife will help her make the necessary hygienic procedures (thrills the crotch, put the enema), will give an individual set of linen - a bathrobe, shirt, diaper. Then, depending on the inspection result, the patient is sent to one of the departments of the maternity hospital: Robble, operational block, separation of pathology of pregnant women or observative separation.
The maternity block is a branch where childbirth occurs, women with fights come into it. In modern Roddomes, Roblock consists of individual boxes, in each of which only one woman gives birth. In boxing there is a bed on which the guinea can relax during the first period of the birth (when the fights are followed); Special armchair (Rachman bed) - on it and the birth of the baby is directly occurring; The KTG apparatus and a changing table with a heating lamp - here the born baby weighing, they will measure, here it will make his first toilet. In addition, each box has a separate bathroom and shower. Thanks to such a system of boxes, childbirth becomes an individual event: even if several women immediately give birth, they do not interfere with each other, and the future dads will be able to attend the baby's birth. In the maternity hospitals of the old design of Ravlock consists of prenormal chambers in which there may be several women and the common maternity hospital. In the prenatal chamber, future mothers will lose the first period of childbirth (contractions), and before starting the female, a woman is transferred to the maternity hospital, where she gives birth to a child and the pilot. And the prenatal chamber, and the maternity hall is fully equipped with everything necessary for the feminine and kid. In Ravlocks with such a design, the overall shower and toilet are in the corridor.
The first two hours after the birth of Mom spends in the maternity department: doctors are constantly watching the woman during this time. Then, making sure the absence of complications, the doctor gives good to move Mom to the postpartum separation.
The operating unit - it occurs in it with the help of cesarean section. In the opersblock, a woman can be directed from the reception office if it requires an urgent caesarean section, or from the pathology separation, when the planned operation will have. Consists of the operability of several operating chambers and a preoperative, where doctors and midwives are preparing for operation. Immediately after the cesarean section, a woman is transferred to the department or the ward of intensive therapy, which are equipped with equipment for continuous monitoring of the patient's condition. In the ward of intensive therapy is constantly a doctor or midwife.
The postpartum compartment - there are already those who came down - immediately from Ravlock or from the Chamber of Intensive Therapy after the cesarean section. Depending on the hospital, the chambers in which women are after childbirth can be single, two or multi-place. If the maym and baby is not provided in the maym and the baby together, then in the postpartum department there is also a "children's" chamber, where, under the clock observation of children's nurses and pediatrician, there are newborns of children. However, today in many maternity homes there are chambers "Mother and Child", where mother is constantly lying along with the baby. In addition, women who concluded contracts for childbirth can live in comfortable "family" chambers with a dad or someone from loved ones.
Also in the postpartum department necessarily there is observation and procedural offices, an ultrasound and dining room.
It is known that future mothers are very afraid of the words "Observation Department" - the branch is so called, where there are non-learned patients or women with any infectious disease (ORVI, influenza, etc.). In fact, nothing terrible in this branch. The observation department is a mini-maternity hospital in the hospital: with its maternity block, operating room, postpartum separation. The only difference from ordinary chambers is in the observation department, all the chambers are always individual, and the sanitary treatment of all rooms is carried out more often than in other offices (which can only please the parents). In some maternity hospitals, they even be allowed from the visits of relatives; In addition, often in the observation department there are "family" chambers!
The department of the pathology of pregnancy - in it there are women with any complication of pregnancy (the threat of interrupts, prestitution, etc.). It usually includes chambers, procedural offices, looking, dining room. The shower and toilet can be both in every ward and one on everyone.

If, until recently, the maternity hospital was a completely closed institution, which was not allowed to have extraneous, today the situation has changed. The future mother can choose the place where her child will be born, and the conditions in which it will happen; Get acquainted with the doctor who receives childbirth, and discuss his wishes with him. A woman has the opportunity to invite close to childbirth (her husband, mother, girlfriend) or a psychologist, as well as make a preliminary tour of the hospital, in order to learn more about the place where one of the most joyful days in her life will be held.

In the consciousness of the future mother, the maternity hospital is often associated with the hospital, and therefore with the disease, the smell of drugs, terrible metal tools and other unpleasant images. Such an idea of \u200b\u200bthe maternity hospital is completely incorrect, but it is easily explained. Fear in front of the maternity hospital is caused by a complete lack of ideas about how the modern rowing anxious institution works. In order to get rid of unnecessary fears and anxiety and get acquainted with the departments and staff of the maternity hospital, we prepared a fascinating tour of the hospital on the pages of our magazine.

Reception office

This is the first branch in which we fall, opening the door of the maternity hospital. Here it is necessarily a hall or a large room in which future mothers, accompanied by loved ones, expect a call to the doctor. The receiving department itself usually consists of three premises: an obstetric post, observation and sanitary room. In the first room there is a table, a couch, scales and a height meter. At the table sits on duty midwife receiving office. Its responsibilities include issuing documents when receiving a hospital, weight measurement, growth, blood pressure, pulse and body temperature of the future mother. Upon completion of these manipulations, the midwife accompanies the pregnant woman in the next room - the observation account, where the doctor is met by the doctor - an obstetrician-gynecologist.

The doctor asks the future mother on the state of her health, the peculiarities of the course of pregnancy, about the causes of circulation and well-being at the time of receipt in the hospital. The resulting data doctor lies in the history of childbirth - the name of the medical map of the woman in the hospital. After the conversation, the future mother is offered to undress and lie down on the couch here. The doctor measures the dimensions of the abdomen and the pelvis, determines the location of the baby in the uterine cavity, listens to the special tube or ultrasonic device his heartbeat. Then the woman is asked to climb the gynecological chair, and the doctor produces a vaginal study. Immediately, we note that when an obstetric examination on a gynecological chair, mirrors or other "scary" medical instruments are not used: in order to determine the degree of opening of the cervix, the doctor is enough two fingers.

After inspecting, the midwife invites future mother to a sanitary room for sanitary and hygienic preparation for childbirth, this concept includes a cleansing enema, shaving perineal and shower. The santic room has a couch on which the crotch processing and the enema, toilet and shower cabins produce.

After the shower, the woman in labor helps to change clothes into clothing for childbirth - "stateless" or brought with them (depending on the requirements of a particular maternity department). In a number of maternity hospitals, the future mother will be offered to change themselves right away as soon as she cross the threshold of the maternity hospital. In any case, clothes must be given to the accompanying, if a woman arrived alone, then things for a while (within the day) will be left in the receiving department.

Maternity block

From the reception office of the fever goes to the maternity hospital, or roblock. This is definitely the most important branch of the maternity hospital - after all, it is giving birth to! In modern male houses, the Ravlock can have two different options for planning. Tell me separately about each of them.

The so-called "boxing" layout involves dividing Ravlock into separate rooms-boxes designed for one woman in labor. Boxing is a room in which there is a regular bed, a bedside table, a table, a chair. Next to the bed of the future mother is a KTG device (cardiotokographs - devices that allow you to register the heart abbreviations of the baby and the contractile activities of the uterus) and, of course, a special device for childbirth - Rachman's bed. Also in boxing there is a changing table and scales for crumbs. In some family branches, Rakhmanov's beds replace more modern obstetric chairs or comfortable transformer beds, which at the right moment with the help of a regular bed "turn" into the device for childbirth. In boxing, the future mother is all 3 periods of childbirth (I period - contractions, II period - sweat, III period - the birth of the last) and 2 hours of postpartum observation. Inspection of the generic pathways and (if necessary), the restoration of damaged tissues is also produced in boxing, and the primary inspection and processing of the newborn occurs here.

Another, the older planning option involves dividing Ravlock to the prenormal chambers, the maternity hospitals and viewing rooms (or small operating rooms), as well as children's rooms. In this case, the chambers are designed for several fencers, in the prenatal ward, women are located during the period I period, as well as about half the II of the birth period (before the start of productive fertility). In such a chamber there are several beds and bedside tables. Here the equipment required to observe the state of the fever and the fetus (for example, KTG) is usually installed. In the prenatal ward, the female can walk, lie on the bed or take special postures.

When a productive fence appears, a future mother is translated into a nearby maternity hall. In this room there are several beds Rachmanov. On one of these beds, the feminine conducts endime II and III period of childbirth. The child after birth is carried into the children's chamber, where it looks, weighed, the growth is measured, handled the umbilical cord and dressed.

After completing the birth, the pledges are moved on a directory into a small operating room, or an observation. The observation chair is located in the observation chair, on which the doctor makes an inspection of the generic paths and, if necessary, restoring damaged tissues. Then the lounge is again placed on a banker next to the head of the midwife of the maternity block for observation.

If everything is in order, two hours after childbirth, a young mother with a baby is translated into the postpartum separation.

Postpartum separation

The layout of the postpartum separation depends on how much Mom's stay and the baby is practiced in this maternity hospital.

With the joint stay of the mother and the child in the postpartum chamber, in addition to the mother's bed, a table, stools and bedside tables, a changing place for the baby, as well as his bed. Mom and the newborn all the time are together. In this case, the children's sister and a neonatologist inspect the baby in the ward, with mom. Children's sister in the first day teaches mom to care for the baby, wash and disguise him. In the duties of midwife postpartum branch

among other things include help in establishing breastfeeding. With a joint stay in many maternity hospitals, it is allowed to use "their" clothes for the baby.

Separate stay involves the presence of a children's office in the maternity hospital, where newborns are located, in this case, mom and kid are found only during feeding - 7 times a day every three hours. The first feeding is usually at 6 am, the last - at 00 o'clock. From 00 to 6 am - a break for sleep. Inspection and other manipulations with a crumb are carried out in the children's office, and then neonatologist bypass moms and tells them about the well-being of children.

The postpartum separation in this case is arranged as an ordinary therapeutic, except for the presence of a viewing room in which women carry out seams and inspection before discharge.

In any case, a visit to relatives can be allowed in the postpartum department. As a rule, it is provided if the childbirth is carried out within the framework of voluntary health insurance or additionally paid the postpartum service chamber of the postpartum separation, it should be borne in mind that only 1-2 people can come to one woman in labor, it is categorically forbidden to pass into the postpartum separation of children up to 14 years old.

Department of pathology pregnancy

In the department of pregnancy pathology, or OSCE, women are coming with pregnancy complications requiring continuous surveillance. Such complications include, for example, gestosis (complication of pregnancy, which is more commonly manifested by an increase in blood pressure, edema, the advent of protein in the urine1 of the threat of pregnancy interruption, chronic feto-placental failure (condition, with a fruit, the fruit is inconsistent with oxygen and nutrients due to deterioration. The work of the placenta), in the department, future mothers are observed and obtained by the necessary therapy. From the usual department of the OPB, it is distinguished by the presence of an examination cabinet, as well as the auxiliary diagnostics and CTGs.

In addition to future mothers who have health problems, they hospitalize pregnant women in front of the planned operation of Cesarean sections. With the trend towards the pregnancy, the future mother is also sent to the OPB.

Other departments of the maternity hospital

In addition to the listed offices, in any maternity hospital there is operating unitwhich includes two operating and auxiliary premises. Caesarean sections are carried out here. Next to the opera block is located department of intensive therapywhere the parent's is observed during the first day after the operation. Caesarean section, two obstetrician-gynecologists usually produce; It helps the operating sister and midwife. On operations, as in physiological childbirth, there is neonatologist. For pain relief during the operation, a anesthesiologist is responsible; He is helped by anesthesist - a medical sister of the branch of intensive therapy.

If after childbirth, the mother or kid have complications, they are translated into observation, or second obstetric branch. In the same department, future mothers give birth, in whom, at the time of arrival, phenomena of Orz or other infectious diseases are revealed or there is no exchange card. This department has a maternity hospital, postpartum and children's chambers.

In some maternity homes provided department of Resuscitation and Intensive Therapy Newborn. The staff of this branch has all the necessary knowledge, skills and technique to push children born in serious condition. Typically, such maternity hospitals specialize in premature births: premature children often need intensive therapy.

Most modern women begin to prepare for childbirth in advance and, in particular, choose a hospital in advance. Obviously, it gives them peace of mind and confidence that childbirth will be safely (see "").

Despite the fact that maternity hospitals may differ from each other, the principles of their arrangement are the same:

• receiving office;
• maternity ward;
• postpartum separation;
• children's office;
• department of pathology.

Some maternity hospitals additionally have a observation department where women come with infectious and inflammatory diseases, as well as non-learned (not having metabolic maps, where information about the health status of a pregnant and child).

How does the reception office work?

Any maternity hospital begins with a reception office. Here the woman must give pre-prepared documents:

• passport;
• exchange card;
• insurance Medical Policy;
• certificate (allowing a woman to choose a hospital herself).

In the receiving department, the future mother inspect:

• measured pressure;
• listened to the palpitation of the fetus;
• determine how childbirth will begin soon.

If the fights are strong and repeated through short intervals, they are sent to the maternity hospital. If the fights are just beginning, then into the prenatal ward. When taking a hospital, a sanitary processing is carried out, where the enema includes (see "") and shave the groove zone (this can be done at home).

How is the maternity branch?

The maternity branch consists of:

• prepar chamber;
• maternity hospital.

Prepar Chamber

In the prenatal chamber can simultaneously be from two to six birthdayrs, and in the maternity hall are usually there are two or three maternity chairs.

In the prenatal ward, a woman is in battle until the cervix opens to the desired width, so the doctor periodically examines it.

Here they also control the pressure, observed the heart heartbeat and the status of the woman itself - perhaps someone will need to stimulate generic activities, anesthesia or other medical care.

Major Hall

With the full disclosure of the cervix, the female in labor is translated into Rozal, where the child is born after the fence. The newborn is laying out mom on the belly, where it lies as long as the umbilical pulsa. Then it is cut and the child inspects the children's doctor, exposing an assessment of its state of the apgar. After the birth of the child, the birth occurs, after which he inspects the state of the generic paths of the woman and, if necessary, sew the postpartum breaks.

Modern hospitals have boxing system - during battles and childbirth, a woman is in a separate box.

Each maternity hospital has a branch of anesthesiology and intensive care and the chamber of intensive therapy, where women are in serious condition (predosis, high blood pressure, etc.) and after cesarean section.

How is the postpartum separation?

Two hours after childbirth, a woman is transferred to the postpartum ward, and the child is to the children's office. Depending on the chosen maternity hospital, it is possible both a joint and separate stay of a mother with a child after childbirth (when a child is brought only for feeding time).

The postpartum chambers of modern hospitals provide for the joint stay of the mother and the child. It is convenient to the fact that the young mother here will help to establish breastfeeding and care for the child (see "").

Usually there are 3-4 moms with children in such wards. At birth according to the contract, Mom may be in a separate ward one with a child. Here every day doctors inspect the maternity hospital and the child, assign analyzes and ultrasound and, if everything is safely, they write home on the third or fourth day.

What is the children's office?

Despite the fact that recently a joint stay of a parental and a child is practiced, children's departments are necessary in cases where the childbirth was heavy and the mother cannot care about the child. For this reason, there are also children born by cesarean sections. In many maternity hospitals there are children's resuscitation, where premature children, children with pathologies or after complex childbirth are kept.

Why do you need a pathology department?

Almost every maternity hospital has a department of pathology where pregnant women are put for monitoring their condition and providing timely assistance:

• in the threat of premature genera;
• fetoplacentage insufficiency;
• inflammatory kidney diseases;
• severe gestosis;
• other complications.

There are women when preparing for a planned caesarean section.

MATERNITY HOSPITAL , the maternity shelter, the obstetric department of the hospital is a variety of institutions intended to provide obstetric assistance (inpatient objects). Stationary objectiveness began to develop as the population concentration and the development of cities. The cities have all the conditions not only favorable to the emergence of these institutions, but even strongly requiring the development of the stationary form of obstetric care. At the same time, roving agency institutions were considered as purely charitable: the main purpose of them was the winning of poor feminines and especially born out of marriage, in the present, the stationary binding is a significant link in the whole chain of maternity and infancy institutions. Since the branching is a branch of preventive medicine, obstetric institutions have a huge general prophylactic value (in addition to their special purpose). Obstetric institutions are known for a long time. Wearing agencies existed in Egypt at the time of Pharaohs. In Western Europe, the first birthmarks of the institutions appeared only at the beginning of the 18th century. (in Strasbourg in 1728). In Russia, the first "maternity hospital" was opened in Moscow in 1764 (now the clinic of Akugaercy and Women. Bth state. Scientific. In-Tu Ohmatmlada them. Lebedeva), in St. Petersburg in 1771 at educational houses. In 1797, an overwhelmed in-t appeared (now the central research obstetrician-gynecological in-t) at all 20 beds. The acquisitive in-t in Moscow was founded by 8 / XI 1800, open 1/1 1801 with 3 beds for the feminine. In 1822, the number of beds was brought to 6 with a total number of births 159. In 1846, an obstetric clinic on 16 beds was opened on Christmas in Moscow. The feminine came directly from the street to the maternity hospital, where they were stripped and bathed. They gave birth on a leather sofa, covered with a whirlpool, K-paradium washed daily and was smeared with souse or oil for softness. Doctors and overwhelming grandmothers were in the performance of official duties in Thractions and dresses. The contingent of the feminine was serfdom, "yard girls", rarely "noble", i.e., the daughters of the broken small nobles, whose children are on a par with others, sent to an educational house. The parental was discharged on the 3rd-5th day. Maternal morbidity reached 30%, mortality - up to 3%. With the developing epidemics of the maternity hospital, the clinic was closed; For summer, it has always been closed for 3-4 months. (Pobedinsky). In Kharkov, the first clinic was established in 1829 in 4 beds; In Kazan in 1844, at 14; In Kiev in 1844, 8 beds. In 1892, according to Grebelchikov, in Russia there were already 10 governmental R. d. (3-in St. Petersburg, one-in Astrakhan, Warsaw, Grodno, Mogilev, Moscow, Oranienbaum, Tiflis), 27 urban (10-in St. Petersburg , 7-in Moscow, 6-in Warsaw, one-in Astrakhan, Kineshme, N.-Novgorod, Saratov), \u200b\u200b5 Zhousek and several private (in various cities, not counting small maternity departments with some kind of b-cc and obstetric clinics with medfaks). In its development, obstetric institutions were different from the following main types: maternity hospitals, maternity shelters and maternity departments. In the largest centers of the USSR - Leningrad and Moscow - inpatient birth developed in two different ways: in Moscow-in type of large R. d., In Leningrad - by type of small maternity shelters. And the one and the other form has its advantages and disadvantages. The main ones are the following. The advantages of R. D.: 1) in the Big R. d. The doctor is constantly on duty; This makes it possible to quickly provide manuals in urgent ■ cases; 2) the cash of several doctors admits at any time the production of large operations, such as waste; 3)

Figure 1. State Central Research Academy of Sciences and Gynecological Institute (Leningrad).

For proper isolation of sick and especially septic maternity hospitals. All this less ■ is provided in small maternity shelters. In addition, several, together taken small maternity shelters, in general, there are more refuses in the reception than if they were connected to one R. d. The main advantages of the maternity shelters approximation of stationary objects to the population due to a decrease in the radius of the serviced area (in the presence of several maternity shelters Instead of one big R. d.). If there are 19 maternity shelters and 6 other maternity hospitals of Leningrad in 1916, each maternity institution accounted for 3.1 km 2.According to Root-Kovsky, in 1909, the feminine from the 1-resistant distance came 508, from the distance of 1-2 versts only 146, and 81 of them were looking for and did not find a shelter in other institutions. It goes without saying that the approach of maternity shelters to the population is determined by the correct placement of them in the city. Further, the cost of the coaches in the maternity shelter is lower (according to pre-war time), the parent incidence and mortality in them is less; However, this last is controversial in view of the fact that usually maternity shelters direct all complex and hard cases in R. d. Recently, in Leningrad (as before and in Moscow) and in other major centers are inclined to organizations of large R. d. in Small cities The maternity institutions in the B-Cah are b. or m. Separate branches of them. In recent years, in the cities of an average scale due to a significant expansion of obstetric care, a concentration in one place and gynecological aid, a tendency towards the elimination of maternity departments from B-C in special premises is becoming increasingly. The obstetric and gynecological clinics of course always have enough insulated obstetric departments. Central Research Obstetrician Gionecol. En-T in Leningrad originated from the rebeling institute founded in 1797 (see above). In 1904, it was built on the initiative of prof. D. O. Ott, by architect Benua, a huge luxurious 3-storey stone building on 208 beds (25 of them for septic bench). Building area 10 656 m 2.with a volume of 160 845 m 3.The cost of the whole building with the equipment is 3500000 p. (Fig. 1). The building is built on the latest science and technology. The general plan and all the details were discussed previously both Russians and Western European medical and technical institutions. In the first floor - rooms for an ambulance, pharmacies, stationery for staff; II and III floors are engaged in obstetric and gynecological departments, a museum, library, audiences and laboratories (Fig. 2 and 3). The main features of the new building are: the absence of little illuminated daylies; large and bright corno-on one side; Pasal lights with chambers only bright operational; perfectly equipped

Scientific and Training Flygel Figure 2. Plan and ^ floor: L-elevators for patients; I. R

Dovalny auxiliary institutions (library, museum, laboratory). Ventilation is arranged with a delivery of 85,624 m Z.in an hour of filtered, heated and moisturized air through easily washed and illuminated by daylight channels. Its electric, plumbing, iceplace, sewage, mechanized laundry, disinfection chamber, bakery, central station for controlling heating and ventilation with all necessary control devices (thermometers, pressure gauges, hygrometers, risostats, etc.). The widespread use of electrical energy for the alarm of the total and from the chambers (to call the sneaks to the patient). Internal telephone and microphones: 1) for signaling

Scientific and Training FlygelFigure 3. Floor III Plan: - IN-mailing machines; S-steam sterilizers; R-Aps for saline.

On the limiting temperatures in the premises, the state of the heating devices, about t ° and the pressure of the hot water boilers serving heating and ventilation 2) ~ for devices to control the employees in their posts and 3) to regulate the stroke of 153 wall clocks. In the obstetric department - 147 beds. Features of it is 2 maternity pavilions working alternately. The capacity of the obstetric branch of 3,000-4,500 bodies per year. New women's clinic prof. Zelheim in Leip "Cyghe. A 5-storey building in the form of a stretched letter P. Chamber with bench occupy 17% of the room. Comparatively low ceilings-3.5 m.(easily accessible cleaning). There are no calls. The electrical alarms of each bed have a button, when pressing a K-Roy is lit in the corridor, a bright light bulb above the door of the Chamber and under the clocks hanging through everywhere in the corridor, and in the sister's room (with the walls of the walls) begins to call the checklist. To challenge the director, yellow light bulbs are ignited everywhere, for a duty-duty-red light bulb. Obstetric compartment - 104 beds; Lazareza - on 48 beds (along with cancer). The principle of small chambers - 6-8 pores in each. The maternity hospital has 6 maternity rooms with 2 homeland beds in each. The walls and doors are made by the sound of the sound that the cries of the fencers do not come to neighboring rooms. The maternity rooms are located in 2 floors 3 in each and communicate with a small inner staircase. For honey. Personnel. Parents and rooms for duty are connected between themselves with a special telephone and light alarm. The walls are painted in a dark gray-blue color, operating-in dark gray-green. Septic department has its own large operating, dressing room and its maternity room, Equipped in the same way as in the above-mentioned pure office. In the upper floor, a branch of 40 women in the last months of pregnancy, which do not have housing in the city and to-rye take from the street; they get a free table, clothes and all Necessary, help the care of BN, work in the kitchen, etc. Oh. work out its bolding during pregnancy, childbirth and postpartum period (as in R. d. in Charlottenburg). In contrast to German clinics, where obstetric institutions are more common only to their departments, in France prevail. R. d., In view of the fact that obstetrics are completely separated from gynecology, K-paradis is interpreted as a special department of surgery. The sample of simplicity and practicality of the device can serve as Maternite de GNO-S P I T A 1 S T.-A NTOINE in Paris, open in 1897. The general plan is depicted in Fig. 4. R. d.-on 70 beds in aseptic and 8 in the insulating department. Consists of a main building in the form of a quadrangle 58 m.shir and 69. m.dl., In the center of the movie there is a kindergarten of 1300 m 2.Separate insulating outlet and machine compartment with laboratories. The total area of \u200b\u200bthe main building 2 602 m 2.The maternity hospital is 4 beds. Its dimensions: 8.90 x 9.67, you. 4.80 m.Bandwidth of up to 2,000 births per year. The insulating department is placed in a special building, has its own operating and utility rooms, separate personnel and households. part. In the present, time to the composition of the typical R. - is the trail. Departments: Reception, Department for pregnant women, maternity branch (birthday) with an operating room, postpartum, dubious, septic, for newborns, consultation with dairy kitchen. In most R. d. (Excluding France) there are at least small gynecological offices. Emergency room. In new and well-maintained R. D, and clinics, as can be seen from the descriptions, the receiving peace consists of at least 3 rooms. In the expected, a preliminary survey occurs, the measurement of T ° and the general inspection of the feminine. From the expected, they are sent or in a pure obstetric department, or in questionable, or in septic. In the pure obstetrician department, the guinea passes through the "handling" consisting of 2 rooms: in the 1st record, the female is stripped, and from this room, the dress and underwear are transmitted through a separate door or a window for storage and sterile, if such equipped . Here, or better in a separate room, the fever gets the enema and ished under the shower; In the next room, her hair breaks off

Figure 4. Paris-Antoine maternity hospital in Paris: 1 -lobby; 2-7 - pregnant women; 8 -16 -Poscient separation; 17 -Open gallery; 18 - closed veranda; 19 -28 - the maternity branch with the reception; 29 -34 -consultation; 35 - 39- insulating branch (separate building).

On the outdoor genital organs and their disinfection is made. She then dresses in hospital underwear and heading to the maternity hospital. Receiving peace situation: in the expected - sofas, couch, chairs, table and cabinet or card boxes and reference books. In the processing: the table for writing and receiving things; In the same or next room, a well-equipped restroom, a bath (with a shower, cold and hot water); in the 3rd room: gynecological table, washbasin, locker, table for protractable medicines and dressing

Figure I\u003e. I Odinanan Committee of the Central Research Academy of Sciences and Gynecological Institute.

Material, brushes, tools, objects of care and processing of the patient and a tripod with an Escamorh mug. The maternity hospital in small and old maternity homes is a larger room with several homeland beds (Fig. 5) and washbasins (with cold and hot water), tables for records and storage of maternity leaves, for care objects and a locker for medicines. Cowards calculation for the maternity hospital - 10 - 12 per 100 postpartum. In most new obstetric clinics, except for one big maternity room, there are 1-3 small ones for 1 bed for eclamps and for pathological clans at all. In the new maternity hospitals, the maternity peace sometimes consists of small individual chambers on 1 bed, in which the girlfriends are located before the start of this activity and only with the start of the latter are transferred to the common maternity hospital. Gathering rooms must have good natural and artificial lighting. Approximately height I 1/2 m.from the floor they are faced with tiles or paint oil paint. The traditional white color in the maternity wards and operating recently is inferior to a dirtless for view of gray-blue or gray-green. The essential part of the maternity rest is a maternity bed, which is often an operating table (to reduce the leg, extracting the fetus, crossing the crotch and even bleaching; all this is better to produce in the operating room). In most cases, maternity beds are somewhat massive and higher than ordinary. In the parental houses named Snag-height of the bed equals 1 m,and the septum is removed in the footing end. Bed prof. Otta-on wheels

reva in her maternity

Kakh; The foot end of it has a metal tripod with a light bulb and nests for the Esmarov mug, a cup for thermometer and tips; In addition, the retractable (on the hinge) metal circle has a bed leg for a lining vessel. Bed height 0,67 m,width-0.75 jw. (Fig. 6). Bed Rachmanova (Fig. 7 and 8): Length in the extended state, Yania-1.75 m,width-0,62. m.and height-0.7 7 g consists of 2 half. It can easily be turned into an operating table with a foot end of the bed on the wheels. Note holders are attached to the foot holder. From the tools, as well as items of medical care for the maternity room, the following are necessary: \u200b\u200bMetal and rubber catheters, scissors. Upholstery and straight, Tazometer, centimeter tape, stethoscope Obstetrician and ordinary, razor, scalpel, spatula, nail-cleaner, nail scissors, mask with Dropper for chloroform, rotor seater, language

Figure 6. Maternity bed is from.

The jacket, rubber wedge for the protection of the bite of the language in the ecralamps and the device for washing the hands (brushes, soapbox, etc.). Overlooking the homeland includes [usually in R. d. Their two: Malaya-

Figure 7. Rahman's maternity bed.

For small, more frequent obstetric operations (crotch sewing, manual extraction, tongs) are large-for serylines (Fig. 9)]. The feature of the obstetric operational is a special toolkit in addition to conventional waste tools (see Obstetric tool). Postpartum separation. In order to better service it is more profitable to have large chambers of 10-20 beds, respectively, approximately the same number of daily podiums. In the Hospital of St.-Antoine, the postpartum chambers of 20 beds do not have a corridor, and the parental as a result of this is under constant supervision of the duty personnel here (Fig. 10). Children are placed in these wards around large tables in the middle; Of course, small rooms are needed for 2-4 beds - ■ for the isolation of ecallaptic bn, the pupils after operations and complications in the postpartum period (noncommunicable nature).

Picture8. Rahman's maternity bed.

Figure 9. Obstetrician operating Vienna clinic.

The calculation of the area and the cube of the postpartum separation is carried out on ordinary hospital standards. The necessary belonging of the postpartum compartment is a dressing, equipped, like a small operating room, but with a non-tiM relative to the amount of instruments, the main thing. arr. Long and short tweezers, pointed scissors with short and long branches for removing seams, spoony mirrors, lifts, sideworks (if necessary), catheters and tips for douching. A room for washing the oil was also required; In it, sometimes sweetening of children (Fig. 11). With the release of premises for newborns, the swaddling and the kneading of children is produced in the children's room. In many normal postpartum departments in the USSR, the so-called

Figure 10. Postpartum Chamber of the Hospital House of St.-Antoine in Paris.

Dubious chambers for herds with suspected infection. For those in each R. d. There must be an isolated dubious separation with its handling, maternity room and small ones 1-2 beds serviced by individual staff. In many R. d. Like us and abroad, the situation of postpartum chambers has been adopted, if possible, a little reminiscent of the hospital. Beds here can be the usual type. It is desirable at the bottom of the nest for a lining vessel. Rest, to-right requires a parental / forces

Figure 11. Washing room of the cannon and swaddling of children in Tsniagi.

Pay special attention to the device of the spring grid and mattress. In Tsniagi, since its foundation, adopted by prof. Otto mattress with partitions in the form of harmonics; Separate sockets are stuffed with a scrupted hair (Fig. 12). Bedside tables must be possible simpler device. In foreign R. d. On the 2nd shelves are placed the necessary objects of care of their parents. For harvesting pants exist in the well-maintained maternity docks, mobile tables, conveniently arranged for the premises on them 9# Walking: mugs, vessels with boiled water and solutions, tools (tweezers, rozents), premises 1) for cans, 2) bikins with dressing material and 3) necessary medicines. Where individual cleaning is carried out strictly, each parent has its own Esmar-Khov mug,

Fig.

12. Mattress of the postpartum bed. Tip, catheter, dressing material, and, most importantly, a separate lining vessel. Insulating office (lazaret, septic compartment). In most foreign obstetric institutions, the insulation department is placed in a separate building and has its own maternity hospital, operating room, kitchen,

I fij g: j

Attazhm. □ SFT Laundry and Separate staff. Sometimes in the same building with their maternity hospitals, gynecological and still even cancer bic (Ven-Sky Clinic and Zelheim Clinic in Leipzig) are placed. However, it is fundamentally important that the insulating department certainly had a separate move and would not be reported to the pure obstetric department. The need for climbing beds is calculated on average at the rate of 15-20 beds per 100 pure postpartum (half-tavs). Considering, ■ that, on average, the percentage of fevering is 10, it is possible to limit the 5-10 beds at the cash of a dubious compartment. The insulating department is arranged with the same components as pure obstetric. In small maternity institutions are limited to the TC device. dubious maternity hospital and chambers for fevering pupils. Insulating branch of the Vienna clinic on 36 beds is placed in a 2-storey building: 1st floor for obstetric cases, 2-y-for gynecological and in particular cancer patients. Each floor has a separate operating room, laboratory, bathroom, buffet and a room for the emergel. Plan of the insulating department of the hospital -st.-Anto-cm. Figure 13. Lazare Tsniaagi is placed in 2 flooded flooded floors separated from the pure obstetric room with a long and narrow, illuminated from both figures 13. The plan of the insulating department of the parental home of St.-Antoine in Paris: 1- washroom; 2 I. 3- restroom; 4 - payments; 5 -The service; 6- house for midwives: 7 - Nature for nurses; 8 - Operational.

Figure 14. Children's bed of the maternity hospital of St.-Antoine in Paris.

Their sides by the corridor; It also has a separate entrance from the courtyard. On the same floor, the mailer is placed - the operating room and 3 maternity rooms of 2 beds, 1 room for midwife, 1 for duty pupils. Another half of the floor and the entire top constitute a postpartum lazaret, 14 chambers of 2 beds in each with dressing, bathrooms, buffet, lurps and material one in each floor. The device of small chambers per 1-2 beds is beneficial for more convenient sorting of bench. Of the small maternity departments of the provincial B-C, the diseased parents are isolated into gynecological or therapy. branches. The insulating department must be serviced as a rule with completely separate personnel from the very beginning of the receipt of the Genovers there, from expected. In order to fencing the infection of pure obstetric departments, but. also for better maintenance of sick T.and in the types of savings in some big cities now strive for the concentration of all septic maternity hospitals in separate large institutions (Moscow, Kharkov, Berlin). Department for newborns, the department of newborns from mothers is carried out in our last years; Therefore, in many existing maternity institutions there are no specially arranged premises for newborns. It is necessary to have a total of 2 rooms: one for healthy,. Other for patients with babies, preferably with boxes for isolation of various diseases. 4 chambers were allocated in Tsniagi for newborns: 1) sorting, 2) for healthy babies, 3) for patients and 4) for healthy babies from patients with mothers. Baby cots are usually arranged with high sides (Fig. 14). The necessary accessories of the branch of newborns are changing tables (Fig. 15),. The table and the cabinet for the necessary medicines and care objects, weighing scales and a washbasin with cold and warm water complement the setting of a room for newborns. DEPARTMENT E NE D L Ber Ein. The device is pursued by various purposes. In many R. d. In Germany and France, these branches are, strictly speaking, boarding schools for poor pregnant women who, receiving a full board in the institution, at the same time perform a notasy work in the kitchen, in

Figure 15. Changing table Tsniagi.

Loved, as well as to care for ben, etc. We work out your content in R. d. SEE € SSR in these branches are pregnant with those or other deviations from the normal course of pregnancy as dependent directly from the pregnancy itself (for example, toxicosis, irregularity from the fruit egg or fruit-incorrect positions, Placenta Praevіa ), so with diseases, former to pregnancy, -tbc, heart defects, hron. Nephrite and other hospitalization is subject to generally the pathology of pregnancy, in particular, and pregnant women with a narrow pelvis, especially where you can assume the possibility of the production of cesaric cross section. Accepted into the ward of pregnant women living away from the obstetric institution to avoid accidental occurrence of childbirth. Department for pregnant women In addition to its deep prophylactic value, it has an important educational value. Gig. The mode during pregnancy is easier to be fastened in practice and is better in life with a living example than instructions. Advancement in this separation is sometimes eliminated from excessive household loads. To establish the required number of seats in such compartments there are no specific instructions. So for example. In the Vienna clinic on 232 beds-48 seats for pregnant women (approx. 20%), in the Cyiagi-20 per 110 obstetric pure (+ 30 insulating), in the hospital of ST.-ANTOINE-9 to 78 obstetric beds, in Zelheim-40 clinic Coutes on 104 obstetric (48 insulating), etc. Levi calculates the number of beds for pathological pregnancy in 6% to normal postpartum. In addition to the chambers in the pregnant woman, desirable: observation, bathroom, insulating, buffet and dining room. Tools for pregnant women usually Next: Tazometer, centimeter ribbon, scales, rodomer, instrument for measuring blood pressure, obstetric and ordinary stethoscopes, tripod with esmarovyski mug and tips, catheters, spoonful mirrors, sidewalls, tweezers, scissors, sideways, mugs With divisions for measuring urine quantity, syringes 1-2-10 h and a table for inspection. The furnishings of the department for pregnant women least should resemble a hospital. Need to organization San. Enlightenment (conversations, literature, red corner device). Staying in the pregnant woman's department will diversify with ugly occupations, a partly of a hospital nature (preparation of dressing material). Separate medical personnel for healthy pregnant women are actually not required. Usually they are serviced by doctors working in the obstetric department. From the middle personnel in the prenatal clinic of Tsniagi by 20 pregnant women (in the prevailing majority of pathological) there are 2 midwives and 5 nurses. In view of the lack of beds for stationary objects, the distance of the distance and inconvenience of transport with many obstetric houses and clinics abroad (and we earlier, for example, obstetric polyclinics are organized in Tsniagi). (Doctors and midwives in turn with traitors go out of R. d. At the request to provide obstetric care at home; in severe cases, the fever is delivered to the clinic.) Obsteric clinics in the West are organized on the principle of self-return and usually for the insured for which they pay Insurance. Improving an ambulance organization in our USSR eliminated the need for obstetric polyclinics. - R. d. In the chain of institutions of Ochmatmlad in direct communication are: 1) consultation(see) for women, 2) consultation(see) for infants and 3) dairy kitchen(cm.). The prophylactic value of R. d. Is not limited to the direct prevention of the complications of the generic act. Stationary obstetric institutions are the best practical school for conducting people's common concepts about pregnancy, about childbirth, childcare and baby. Maternity shelters. In Leningrad, the type of normal maternity facade of the 10 -20-bed rustic shelter was developed. The shelter for which the following requirements were considered necessary: \u200b\u200bNormal 20 bedroom shelter (Fig. 16 and 17) must have an area of \u200b\u200b560 m?and volume 1 900 m 3.at a height of 3,4. m.Of these, 225. mr.economic premises and 335 m 2.- Hospital premises (ratio 2: 3). From hospital rooms 215 l * 2 is employed by chambers and 120 m?-proof hospital rooms: reception, observation, processing, maternity, operating room (rel. 1.8: 1). From 225. m *hose Premises 140. m *assigned to the apartments of midwives and nurses. In Round Digits: Hospital compartment 8/6 of all rooms, households. room - a / 6 - at the same time, the wage - a / 5, observation and so on .- "And for staff and

Figure 17.Land 10-20 bedroom rural maidial shelter: 1- insulating; 2-middle; 3 wards; 4 -rinal; 5-operating; in-Belly; 7 observation; 8- bathroom; 9- restroom; 10- hallway; / 1st pantry; 12- kitchen; 13- nurses; 14 - Sterilization.

V 5 for kitchen, linen and other houses. premises. Type of normal 30 bedroom: Area 825 m gheight is somewhat less than 4 m.Square of the hospital room 500 m 2,square chambers 300 g * with air content 1,200 m 3.Thus, on 1 bed accounts for 10 mr.square (in Poltavtsev-9-11.5 g 2) and 40 m 3.air (in Poltavtsev-30-35 m 3)House area. Premises-325. mK The obstetric departments of the large clinic in nature "are approaching R. d., And small obstetric branches of the B-NIC-NIC-MAIL officer The department should not communicate with others, must have a separate course, special staff and their underwear. Isolation of the sick-haired maternity hospitals is usually carried out by transferring them to gynecological or therapy. Department. Personnel R. d. Calculation of the required amount of it, in compliance with all the rules of labor, It is extremely difficult thanks to the need for permanent duty in the maternity branch of at least 2 doctors in order to be able to organize the necessary operational allowance. Often in large R. d. On duty at the same time more than 2 doctors, and non-standard joined. Non-standard doctors on duty for purposes Improvements. This explains the strikingly small staffing staff in many R. D. Nice. According to the Circular NKDR, from 30 / ІX 1929 in R. d. And the maternity department was supposed to be 1 doctor of 35 beds, 1 person of medium and younger staff-8, not counting the sister-hostess by 40-50 beds and for each department 1 nanitars with bathroom, 1 with bafth, cleaners and special staff for the operating room. For the children's room - 1 doctor at 40-50 beds and 1 sister on 12 beds during the day and 20 night. In most R. d. 12-hour duty adopted. Middle and junior staff in the USSR on duty on labor standards. In large R. d. Doctors lead a delivery of the primary boring and carry out childbirth in Pat. Cases. The midwives allow normal childbirth and help with operational allowances. For the delivery of infected lies, a separate junior and middle personnel and a separate doctor from the brigade on duty in clean care are distinguished. In severe cases, other doctors are also involved. In many foreign clinics, the septic separation is absolutely isolated father-stoma. In the postpartum pure office there is a separate personnel. The nature of the work in R. d. And the maternity shelters of large cities is poured. Pat. Cases are usually concentrated in R. d. It took place especially at the same time, therefore the incidence and mortality in R. d. were quite high. In the dohantiseptic period of R. d., Especially those in which the teaching was conducted, were the foci of terrible epidemics of the maternity hospital. Mortality in them reached such limits that the question was raised about the full destruction (Le Fort in France). With the introduction of antiseptics and aseptics, the danger of infection significantly decreased, although before the present, the time is still not eliminated. Due to the concentration in R. d. Heavy cases, operational activities in them are significantly higher than in the maternity shelters; Therefore, an appropriate situation should be created for it. In half of the 19th century in the St. Petersburg obstetric clinic for 8 1/2 years at 543 gods, forceps were imposed in 30 types (5.5%), the turn on the legs-14 (2.6%), on the pelvic end-17 (3 , 1%), manual separation of last time (4.9%), punching head-2. Embryotomy-2, Kefalotripsy-2, Becution with ectopic pregnancy-1, Ke-Sarah section on the dead-2, Accouchement Force-3 and artificial premature different-1. After the introduction of antiseptics and aseptics, with the improvement of operational equipment, the T. N. Hir. The direction of ^ obstetrics, and the number of operational benefits (cesaric sections) increased significantly, especially in the United States. It, in turn, increased the incidence and mortality in R. d. According to the statistics of Slavyansky for 1889 in St. Petersburg: p Oddomsoguent institution Mortality Pouryper. (in%) Neppuper. (in%) in obstetrician, wedge. honey. Fact . . Rod. Creative With the oblast, school genus. Creative without obstrive, school genus. Departure B-csy with an overworn 0.43 0.22 0.11 0.48 0.35 0.78 0.39 0.15 0.73 .0.71. Departure B-Tsy without obstacle- morbidity in St. Petersburg for 1904-12. The disease in the maternity shelter (in%) in the St. Petersburg maternity institution (in%) is a faceless. Period septic disease Likhor. without a diagnosis. . Postpartum unusable disease. . Common diseases. . . 91.2 1.8 4.9 0.8 1.2 89.4 3.2 5.2 0.9 1.2 Equally, child mortality due to the same conditions in maternity hospitals is somewhat higher: the foundation was born. Alive Nemaceryer-Maceryer- (in%) of bathrooms (in%) (in%), the maternity shelter. 96.6 1.9 1.5 s.-Petersburg. Romal agency. . 95.5 4.5 Overlooking Gine-Colasticine In-T 95.3 2.66 | 2.04 The role of R. d. In training. R. d. Almost since their occurrence, they served as a school for the preparation of obstetricians and midwives, both in Russia and abroad. Research activities in R. d. Began in Moscow since Richter Father, in St. Petersburg in St. Hir. Academy since 1848, when the obstetric department took Kaiter, Pirogov's student (although the work and articles of a pedagogical nature were published before). In the future, many R. d. And the obstetric clinics have become major scientific centers and released dozens of scientists and hundreds of work on obstetrics. LIT:Obstetric and gynecological institutions in Russia, VPB, 1910; Bubichenko L., practical instructions for the device of the maternity hospital, P., 1915; oh e, akin to Petrograd and his role in the protection of motherhood and infancy, journals. OKR. mat. and young, 1916, № 7; City maternity shelters in St. Petersburg in 1868-1885, St. Petersburg, 1887; State obstetrician-ski gynecological-t in Vleningrad in 1904-1929, M., 1929; E V N and N I., obstetric-gynecological clinic and hospital branch in Berlin, Zh. AK. and NKen. B - it, 1929, number 3; Egorov, a new women's clinic prof. Zelheim in Leipzig, Gynech. and Akush., 1929, No. 2; Kennedy R., obstetric and gynecological activity of the Chicago hospital and the dispensary for 1918-1925, m., 1928; Kiselev N., description of the St. Petersburg, akin, a magazine AK. and wives. B - it, 1903, number 8; About Sipov V., Motherland Cry, Rus. Doctor, 1909, №5; Pobedinsky N.ISHE-PANOV L., Some materials to the 125th anniversary of Akush.-Gyneek. Clinics 1 MSU, Gynech. and Akush., 1931, No. 4; Poltavtsev A., Hospital construction, M., 1927; Re d l, Akush.-Gynech. Clinic Wille, St. Petersburg, 1908; Feder E., our tasks in the field of objects, a magazine for the study. wounds Children. age, t. Vі, № 3, 1927. See also lit. to art. Relative.L. Bubchenko.Relative-to-provision of obstetric assistance during childbirth. The correct organization R., constituting one of the main prerequisites in the fight against deviations from the normal course of pregnancy, with the maternal morbidity and mortality, is the main link in the chain of events on The protection of maternity and infancy. R., that is, the system of assistance in childbirth, in Russia, as in the West, not immediately adopted those forms, which are held now. R. As such as elementary primitive assistance at birth existed in ancient times, there were also savages, there were also among the ancient Russians, and in the ancient Slavs. It was carried out by experienced older women, which were called grandmothers-films. The first assistants during childbirth almost everywhere were the shepherds, which were concerned about the observations of animals, how childbirth occur, and in difficult cases were forced to assist their animals, taking out the fruit, making a turn, etc. The first primators of organized objectiveness in Russia It should be attributed only to the mid-18th century, when the first obstetric schools appeared. The first overwhelming bars were invited only to the royal houses and to a major serving nobility, yet the rest of the urban and rural female population was in the hands of ignorant rents, illiterate village bars. - In 1764, the first roving place was created at a Moscow educational house. At first, it was organized on 20 beds for unmarried women, they had the nature of the help of secret women in labor and it was probably designed for those harvests from the highest layers, which under the conditions of that time were to be resolved somewhere in secret asylum. In 1771, with an educational house in St. Petersburg, the second maternity hospital was opened. The third maternity hospital was organized in 1797 and already wore the character of a real generic institution for all of all married femalenits, and with it there was an overwhelming In-t, from which the current Leningrad State Gosud grew. Akush.-Gynech. In-t (b. prof. From). In 1801, Novivinal Institute was organized at the Moscow Educational House. In the provincial cities of that time, the post of city obstetrician was introduced to assist the population according to R. The period of urban and Zemstvo medicine can be called the third period in the development of R. Naturally, the landowner of the Zemstvo could organize honey. The help is so wide, in a planned manner, how this was required by the interests of the wide working masses of the masses of the peasantry. In the hands of urban and land self-government was the organization honey. Assistance in general and in particular R. until the revolution of 1917 in 1866, when the land of the State of Zemsky and urban self-government was formed in the Moscow province, on the Zemsky Assembly, San was chosen at the Zemsky Assembly. Commission, Kraya amounted to « Proposal for the organization of Zemstvo Medical Assistance in Moskovskaya province. " Paragraph 12 of these "proposals" says on how to organize obstetric care to the population with the help of rents. It was assumed in each village to have an educated obesive grandmother, K-paradium would constantly live on the site and would be known to the peasantry. With her, a woman was selected from the villages in this area. The chosen woman remains at the heaven grandmother 2 years. In the continuation of 2 years, the obesive grandmother is obliged to teach the peasant, as to act during childbirth. This woman can take care of the bic in rural b-tse. After a 2-year term, it is released into its family, and another elected from another village is coming to her place. T. about. It was assumed that in a few years each village will have his own bullie with practical knowledge. If you remember the cultural level of midwifery of the time that was prepared by the "heavenly instruction", if you imagine this rural passionate grandmother, K-paradise, in turn, was to teach the peasant to this case, to imagine her cultural level and the level of its knowledge, then one can judge that Quality R. was at that time extremely low. In 1876, at the first congress of the Zemsky doctors of the Moscow province again floats a similar "position" from Dr. Peskov,. C-ry suggested that the zemstrost to prepare peasants in urban anniversary institutions to the role of rents. The congress on this occasion decided: "It is desirable that the zemst is the preparation of the acquisitions at its own expense, but that later they should not be discouraged." True, in the Moscow Zemstvo, these obstacles were not intensified, but the idea of \u200b\u200bscientists of obstacles has repeatedly emerged in Moscow and in other languages. Many Zemstvo, at the proposal of prof. From 1897, in 1897, they formed a "contingent of persons with the rights of agricultural ski-obstetric practice", preparing these faithful grandmothers of the 2nd discharge-on courses at the Zemsky district and provincial b-cc. In order to enroll on these courses, it was not at all necessary for educational qualifications, only literacy was needed. The term of learning H & these courses was annual. For a long time R. in rural areas at best was in the hands of these rural rents, grandmothers, while the cities needed already-more qualified obstetric care. The cities were the overwhelming "grandmother of the 1st category, which were already trained in special schools organized for learning obstetrics. Around 1870 of the last century, the question arises about the organization R. to the city's population. The reason for this was the colossal outbreak of the maternity hospital, K-paradise in 1868 in St. Petersburg gave a mortality rate of 20% of all herds. It was then that urban self-government raised the issue of making urgent measures to develop obstetric assistance to the city's population, and stiguous grandmothers and rural midwives began to prepare, and rural midwifery for the village of Ga and for the city-paramedic city. In addition to Moscow and St. Petersburg, maternity hospitals are organized in Voronezh, Perm, Kharkov, Yaroslavl. According to the statistics of Dr. Grebenshchikov, in 1892 there were 10 states. Mare Houses and 2 urban hospitals. But if at this time you can talk about more or less satisfactory maternity assistance in cities * The organization of it in rural areas still remained very weak and the question about R. was often forgotten by the depots. Veselovsky in the "Land History for 40 years", in assessing the general state of maternity assistance, writes: "On the organization of obstetric assistance in the land we will not have to say a lot, for in this respect there is almost nothing." Seeking to reduce the obstetric assistance, the Zemstvo was taken to the hospital service, which were engaged in the B-Que, could not focus on the development of R., and the obstetric assistance turned out to be in addition to them, because they had time to do it in addition to their main duties -The, in any case, only when they were called for childbirth. As for the unearthly provinces, then with obstetric help in rural areas, it was even worse. In 1904, 98% of all kinds, according to the Rhine, are serviced by illiterate obstacles. Even in 1914, there were only 6,876 beds in European Russia, and in addition, 283,386 genera adopted by midwives at home, which amounted to a total of 10-12% of the provision of qualified obstetric assistance in relation to the total number of birth and Only 4-5% in relation to the number of births in rural areas. The development of R. as an organized system went two different ways in St. Petersburg and Moscow. After the epidemic of 68 in St. Petersburg, as an emergency measure for the organization R., the organization of small maternity shelters was launched. The shelters were opened in ordinary apartments, 2-3 beds, worth 250-300 p. This organization R. lived to the October Revolution. The revolution found this system in Leningrad and partly in Moscow, and the organization of small maternity shelters is a distinctive feature of Leningrad. In Moscow, urban self-government went on another path, along the way of organizing major maternity hospitals and maternity departments with B-Cah. Help at home urban midwives did not receive development, and the stationary system is the main form of R. in the cities. When studying the issue of stationary R. should be part of the experience of Moscow and St. Petersburg, where the organization of objects actually originated. In these two major cities, the growth of the stationary system was always dependent on the overpowering of apartments, from the growth of the sediments and from the predominance of its poor layers. The sharper the housing crisis, the more increased the number of applicants, the faster the city self-government was forced to deploy the network of maternity beds. Mooding shelters in Leningrad were not organized as specially built, maternity institutions. The shelter was arranged. h. in an ordinary apartment; It was primitively equipped; Birth was taken by midwife. Even after the October Revolution, when the protection of motherhood and infancy began to be carried out on a state scale and in a planned manner, the maternity shelters did not have independent doctors who would have been made by this shelter. Sometimes 1 doctor relied on 2-3 shelters. Doctors' duty at all. The duty was produced in such a way that one doctor was on duty on all the maternity shelters of the city of Moscow. In the maternity shelters, the childbirth was held by midwife, the doctor was called only on Pat. Birth. Only the newly organized subwakehold of the Maternity and Infancy of Moscow Healthcare destroyed in 1921 this system of work in the maternity hospitals and resolutely stood on the path of consolidation of maternity institutions, on the way of organization instead of primitive maternity shelters-major maternity homes. When the Maternity and Infancy Department of the NKDR was organized. In 1918, in Moscow there were only 600 maternity beds. The largest independent maternity homes was 2-Lepheinsky and b. Apricot-sky (now N. K. Krupskaya), organized only in 1900 A. N. Rakhmanov. In the following 1901, a large public worker, a city government doctor G. L. Grauerman, made an extensive report on the organization R. in Moscow. Grauerman and Rakhmanov can be considered the founders of Moscow R. to them in Moscow there were only 254 beds, and in St. Petersburg 357 beds. Graueerman and Rakhmanov were among those specialists, who were among the first to participate in the work of the Maternity and Infancy Department after the revolution. It would seem that such a type of obstetric assistance organization, as the maternity shelters, is clearly represented by an imperfect relatively with the maternity hospital. However, among the Zemsky and urban doctors there were defenders of the same system, and in favor of the organization of obstetric assistance in the form of small maternity shelters, pretty weighty arguments were brought. It was indicated that this help is cheaper that it makes it possible to bring over the obstetrics to the population anymore: the maternity shelter can be arranged on any outskirts, in any house; There is no need for the operating room for the provision of operational assistance to the feminine transported into a specially equipped obstetric institution; The doctor is not on duty, but the midwife on duty, hence the doctors need less. The maternity shelters are organized on the periphery and still, especially with the rapid growth of large cities and new buildings, where the construction of quite developed and well-maintained honey. Institutions does not keep up for the growth of the population. In 1906, the stationary obstetric assistance in St. Petersburg according to the Rhine data was 58% of the need. In the provincial cities, it was 10.1%, and in county cities 1.2%. In the 12 provincial cities there was not a single maternity bed. Obstetric travel assistance in 33 Zemsky lips. was 5.4%. Only in the Moscow lips, where the best cultural forces were concentrated, where it was the richest zemstvo, R. was only 12.4% of the need. It should be noted that the traveling obstetric care ch. Obr, referred to the villages, because, as mentioned above, the help at home in the cities always occupied an extremely minor place. True, at the end of the 19th century. The position of the city obstetrician was created, which could be invited to help at home and was intended for the inhabitants for workers, for the poor. But if we remember that 13 people on the outskirts of Moscow. lived in one rope apartment for 3-4 people. In the room, it will be clear that such a population of the obstetrician did not cause, but brought the feminine to the maternity shelter or to the maternity hospital. There were in the cities and private obstetrics, but the help of these midwives, they used relatively prosperous circles. Poor, the working population was used by the services of obstetric institutions, where there was free help, or did not use any obstetric help. After the revolution, private obstetrics almost went on-no. In the West, helping at home is prevalent. In Europe, there are no urban maternity homes for the mass service of the population. This assistance is only in the order of "Assistance Publique", i.e. helping the poor. Like all medicine in the West, R. by the benefit is the case of private doctors and midwives. This assistance also turns out to be hospital cash desks, but also hospital cash desks do not have their hospital institutions and provide medical assistance, paying for a certain tariff and agreement of any doctor, which is obliged to visit the insured at home or take them at home. Large, well-furnished obstetric institutions serve as clinics for the purpose of university education. Soviet R. Bodies of Maternity and Infancy, taking R. into their own hands, set the task to rebuild R., giving him, as well as all his institutions and events., Preventive nature. Prevention consists primarily in the fact that the organization R. begins in the USSR not from organizing a maternity bed, but from the first stage, with the organization of consultation for women. Extring R. organization of consultations for women, this most attaches to him a completely new, preventive nature, because consultations belongs to a decisive role in the study of the pathology of pregnancy and inevitably associated maternal morbidity and mortality. The work of the consultation is complemented by the organization of the patronage of pregnant. During the period of the Zemskoy and urban medicine, obstetrics and doctors in the region R. were limited to those who took birth when they were brought to the woman in labor or they were caused to the guinea. The task of the Soviet R. is not to wait, but to attract the fever to the maternity bed, which is of particular importance in the village. The organization of the patronage of pregnant woman is one of the main, methods of working advice for women. The continuity of observation of a pregnant woman, the pity and mother with an infant is established by introducing mandatory so-called. Revolving letters: About each pregnant woman under supervision, with its direction in the maternity hospital, this last is notified by sending a double postcard. The tearless part returns to the consultation by the maternity hospital with marks on the time of statement, childbirth, complications, the need for patronization. At the same time, the maternity hospital sends a similar notification to consultation for infants, which immediately through its patronage sisters should take a newborn under observation. These preventive motions change the whole nature of the organization of obstetric assistance in the Soviet Union compared with the past. - Third new moment, the progenit organs of maternity and infancy contributed to the organization R., this device of offices for newborns in the maternity hospitals and in the maternity departments. Until the Soviet period, the newborn was placed in the same room, where and the parental, and did not have some beds, and slept with mothers. The protection bodies of motherhood and infancy consider the elementary requirement to be made to the home office so that it was there that the beginning of rational child care was laid. It is necessary to create children's branches, where the child immediately patches to a certain mode, and the mother in the postpartum period has a full rest. However, the maternity homes do not occupy the prevailing space in the organization R. Independent maternity hospitals make up a relatively minor percentage of generic institutions. In most, the anniversary institutions are the maternity departments with large B-Cah. Even now in the B-Tsh rather large former. "District cities Very often, these maternity departments do not even stand out in a particular compartment with a separate entrance, a separate corridor, separate technical personnel. Most often it is separate chambers in the general corridor, which are often placed next to HIR. and ter. Chambers and in a very slight degree are fenced from the infection of infection, K-paradium is possible in common B-CHA. In large centers, the maternity departments are more isolated, in better cases in separate buildings of B-TSA. Independent maternity hospitals were 3% in 1926 * and had 3,832 beds, in 1927 the number of COUGHWSMO-standing maternity hospitals Doschloudo 5 045; According to the 1930 census, the number of maternity hospitals in the USSR 171 with the number of beds 9 775. T. O. The number of independent maternity houses is growing, etc. This is large institutions, they include about 30% of the maternity beds and were held in 1930. 223,163 genera from the total number of 780,575 bodies in the USSR. In the maternity hospitals, the gynecological department is also required. - With the existence of maternity departments in the general framework of the B-TSI, the relationship of the protection of motherhood and infancy with therapeuts is that the authorities of maternity and infancy are prescribed by the head of the maternity department; This head is obliged to report to the protection of motherhood and infancy and in addition to reporting, it is obliged to carry out those rules of the internal schedule, which are prescribed by the protection of maternity and infancy. - With the transfer of the R. in the management of maternal and infancy authorities in it, there was a certain shift: the number of maternity The beds increased annually, the number of obstetric items increased dramatically; The consultations for women began to deploy; The nature of the training of midwives has changed, and new courses have been introduced into the program of the obstetric departments of technical schools - the organization of the protection of motherhood and infancy, child care, which has increased the type of midwives and made an employee who has been able to carry out, along with special work on objects, wide recreational activities in The rest of the woman and the child, especially important in the conditions of the rural sector. To strengthen the pace and improve the quality of maternity assistance to the NKDR decree. From the 1st / XI 1931, 20% of all beds were allocated in all B-Tsh of the city and the village for childbirth and the maternity departments were organized in all medical ambulatory areas (the official department "at the Health Frotement", NKDR., № 13-14 1931 ), and in 1932 it was allocated in the NKDR system. Special Office on R., the organization of gynecological aid, abortion and struggle against abortions was included in the function of the commercial and abortion (the provision of the management of the objectory approved by the NKDR collegium. 15 / X 1932). The relationship between the new management of the birth and management of hospitals, which includes the maternity departments in hospitals, are scheduled for approximately the same as it is indicated about the relationship between the Maternity and Mediation Protection Department. When organizing the Soviet R., such functions that they have not performed before, namely, the production of abortions in SOTC are granted. Indications, and part of the birth beds in the urban network was allocated for abortion. Until now, abortion bows occupy a fairly significant percentage of maternity beds in general. Their number was at least 30% of the total network of maternity beds in the republic. When the organs of maternity and infancy, they have taken the organization of this assistance in their hands, they were forced to highlight the beds for abortions in the maternity hospitals because there was no other medicinal beds for this type of assistance, as surgical, gynecological and other abortions cause a certain overload of the maternity Copes, reducing the cash network of beds, respectively. And when the percentage of customer satisfaction is calculated by the number of beds, it is necessary to keep in mind that this percentage is actually lower. In general, practice has shown that abortion beds are more expedient to bring to gynecological or hir. B-Tsu, that, however, it is rarely possible, or to stand on the way of organizing independent hospitals for abortion. T. about. In the organization of the Soviet R. The following new elements have been introduced: Organization R. begins in consultation for women; Consultation has been established for women with a maternity hospital and a maternity hospital with advice for infants, and so. A continuum chain of events in the maintenance of a pregnant, parental and mother with an infant child was created; R. took an active in nature by introducing a patronage of pregnant women's service of newborns allocated to children's departments and finally in the system R. included abortion assistance. This should also include the organization of a special commission for the study of contraceptives. Quantitative indicators of labor are characterized by the following data. Table. 1. The number of maternity beds (data department of the Maternity and Infancy Department of the NKDR. And the management of objective). Years City Village Trucks Total 7 893 5 060 14 034 8 631 5 863 15 712 6 241 19 076 * 12 994 6 993 Water 19 987 13 793 6 923 - - 20 719 13 133 8 267 - 10 111 25 209 17 602 12 607 30 459 * NKDR data without auto other republic and Nizhnevo-r zhska KRG 1I. In 1927, by the beginning of the first five-year plan, the service of the needs of cities was 86.9%. This percentage of the provision of pure acoustic assistance: abortive beds are highlighted. For the village, the indicators are lower and characterized by the following numbers: 1925 G.-11.6%, 1926 G.-12.2%, 1927. -2.88%, 1928, 11.3%, 1929 - 12 0%, 1931, 13.0%. Recall that according to statistics prof. Reina to the revolution was 4-5% of service. Average service performance throughout the RSFSR stands on such numbers: Table. 2. Years percentage of service years Percentage of service 1925 1926 1927 20.8 21.0 22.8 1928 1929 1931 23.2 29.1 26.1 At the congress of gynecologists in Kiev in 1928 it was recognized that the provision of R.-in Cities can be considered almost stable that we have almost achieved a maximum that we have 86% of service without abortion and that it remains to serve 14% to maximize the obstetrics all the urban population. Reduces the average percentage in the republic is almost a complete absence of obstetric assistance in rural areas. In Zap.-Europe. Women's clinics are discharged only on the 12th day. In the USSR, even in such cities as Moscow, Leningrad, stay equals only 6 days, and in large district cities and in the district b-tseh, this period is reduced to 3-4 days. When drawing up plans for the organization R. This KDUF. Amendment must be made. Accurate data on the number of births conducted in the obstetric institutions of cities and prom. The centers, no, but data on the cash number of beds in the cities in 1931 show that they are enough for 100% coverage of childbirth, provided that one bed will serve 50 births per year. Table. 3. Data for 1931 according to RSFSR. Population of cities .......... 23186.9 thousand. Fertility in cities ........ 28.2 ° / 0 On the number of born .......... 653 873 Covers .............. 14,983 The number of possible R. on the beds (1 bed - 50 genera) ........ 749 150 The table below shows that part of the maternity beds or busy Abortions, or empty, or serves the population of the nearest rural areas. By the beginning of the first five-year plan, the service indicators of the reflection in the district section were given a rather dead picture. Table. 4. Number of maternity beds by 10 00) population (NKDR data. For 1S28-31). Areas on average in cities in rural. locality. Ivanovo region . . Leningrad region. In total. Leningrad North Territory. . . Nizhny Novgorod Region North Caucasus. . Western region. Medium Volga. . . Tatroprib. . . Siberia ....... Western Siberia. Eastern Siberia. Center.-Chern. oblast . 3.9-4.8 3.5-4.6 3,5-4,1 3.2-5.7 2.0-3.06 1.9-3.7 1.5-2.4 1 , 4-2.0 1.2-1.3 1.2-1.66 1.2-1.59 1.2-2.1 1.1-2.0 1.97 2.1 0.8 -179 10.2-11.8 6.5 - 6.2 10.8 4.3- 4.47 9.0-12.9 1.1-12,5 7.0- 8,1 4,4 -10.6 4.1- 4.46 5.2-6.07 8.9-6.18 6.0- 5.3 8.1- 8.5 4.3- 7.5 3.7 6.7 5.5- 7.05 2 0-2.3 1.3-2.03 2.5-3.8 1.9-3.1 0.9-1.7 0.8-2.1 0.6-1.1 3, 7-1.4 0.8-0.8 0.4-1.05 0.6-1.02 0.4-1.1 0.5-0.98 0.98 0.93 0.7- 1.2 Thus, by the end of the first five-year period, the relationship between the city and the village has changed for the better, and the numbers show growth almost twice the maternity beds, ch. arr. in rural areas. The norms of the organization R. When drawing up the first five-year plan in R. believed that the maternity bed should work 320 days. If you count 8 days of stay of the maternity hospital on the bed, then the bed will miss 40 births per year. In rural areas, the presence of a maternity hospital has increased to 6.4 days, while in 1928 the average duration of staying in the maternity bed in rural areas was 3.2. Twice must be improved by R. Qualitatively. The number of births, to-ryo misses the bed in rural areas, was taken for 50. In the compilation of the second five-year plan, it proceeded from the following rules: 8 days of staying on the bed in cities, agro-industrial centers, MTS and state farms and up to 6.5 days for collective farms. Consequently, the quantitative indicators are taken the same as for the first five-year plan, since the control tasks of the first five-year plan were unfulfilled. At the first five-year planters, the average percentage of R. coverage was to be 40% (100%-in the cities and 26.2%-in rural areas), and was carried out by 1/1 1932, an average of 26.1%. It would be necessary to almost double the number of cash maternos of 1927 to serve only the population growth. And the bulk would remain at the same level of service, i.e. by 12%. Taking into account all these numeric indicators, the organs of protecting motherhood and infancy came to the following notes. The organization of inpatient care is undoubtedly the best form of organization R., but inevitably and it is necessary to add it to the organization of obstetric items. The activities of the obstetric paragraph of the Maternity and Infancy Protection Authorities gave the character preventive and thought of them as a primary cell of maternity and infancy in the village. The obstetric item is an midwife, equipped with an obstetric bag, K-paradium contains everything you need to carry out normal genera at home. Obstetric items must complement the B-CSU and should be located close to the area. The average distance of the arrangement of the obstetric item from the hospital- 5 kMon average, in any case no further than 10 km.The obstetric item is located on the periphery of the site and subordinate to the district doctor. The function of the obstetric point-pregnancy and childbirth, san. processing of the female population, carried out by organizing the patronage of pregnant and postpartum; Patch selection. Cases of pregnancy, to-ry obstetrics should be directed to the precinct maternity beds; Organization of the initial proper care of new-born, organization of patronage of infants. Complications for childbirth are about 25%. This percentage of complications during childbirth should be hospitalized. The midwife must carry out normal childbirth at home on sterile underwear, which it has in his bag. Radius 5. kM It is necessary to consider the Middle, the to-ry allows normal appeal to the maternity hospital. Improving the road business, the collectivization of agriculture, with the reasons of the collective farm ensures the delivery of births in the B-CSU, should continue to provide the possibility of using B-Tsei and at more distant distances. When organizing an obstetric item, it is attached to it a strictly defined area determined by the number of people. The midwife can spend about 100 genera per year. When fertility is 45 per 1,000, one midwife should have about 2,000-2,500 residents. The obstetric paragraph of Nuusho to give a certain territory, because the correct organization and the correct activities of the obstetric item necessarily implies patronization of pregnant women, San.-Pro-Light. Work and patronization of infants. Along with the specified form of assistance, the obstetric item participates in the work on the improvement of women's work in the collective farm: determines the period of pregnancy, gives a certificate of free from work on pregnancy and feeding on the deadlines established by the collective farm, gives references about the need to translate pregnant collective farms to lighter work, seeks from the board of a collective farm highlighting vehicles to deliver the feminine in the B-CSU, participates in the organization of the Brigades, pursuing the goal of the correct placement of female labor force in the interests of pregnant and nursing mothers, and participates in the work of the Cashizer's mutual assistance, seeking benefits for benefits pregnancy and childbirth. With the collectivization of agriculture, the mass deployment of collective farms and state farms, the approach to the organization honey was radically changed. assistance in the village. The main collectivization area is becoming the center of the area of \u200b\u200bsolid collectivization, machine-tractor station. There is supposed to build a large b-csy, qualified honey will be concentrated there. Help, including maternity institutions: maternity hospital or maternity hospitals, consultation. On the second five-year apartment of the NKDR. The following preliminary missions on the organization R.: bring the coverage of R. in cities to 100%, when staying on the bed to 8 days. On new buildings: 100% coverage of stationary obstetrics at least by organizing a temporary type of maternity institutions in the premises of the lamb type and the largest working villages. Two forms of maternity assistance are left in rural areas - stationary and obstetric care at home by departures of midwifery B-TSA or an obstetric item, and the nature of the service of individual areas of the rural sector: Agro-industrial bases and energy centers of the district must be served 100% inpatient help and 50% obstetric help at home. Stay on the bed is brought to 8 days in agro-industrial bases, state farms and MTS and up to 6.5 on average for collective farms. The main groups of the village population of the village (in the agro-industrial base, state farm, MTS) should be covered by consultations for women: the selection of pregnancy pathology should be properly organized through them. Cardridge visits should be brought to 2 for each woman in the postpartum period. Underground abortions should be eliminated in full both in the city and in the village. Hospitalization of all abortions with stay on the bed on average 3 days after the production of an abortion operation should be achieved. To do this, special hospitals are deployed in cities for I produced artificial abortion "or an appropriate number of beds in obstetric and gynecological institutions are deployed, and t.rural areas - in all obstetric-gynecological departments of district B-C at the rate of 1 to 5-10 maternity beds, and they must be separated from the maternity beds. With all the consultations, techniques are organized to prevent pregnancy with the coverage of the female population of the productive age. The plan introduces the organization of consultations on sexual hygiene under all consultations for women, medical ambulance with gynecological reception, and in rural areas and at obstetric items. When planning an obstetric and gynecological network in cities and industrial centers, projects proceed at the rate of 100 thousand people: obstetric beds-80, gynecological-60 and abortion 12. LIT:The second five-year plan in OKR. mat. and young, okhr. mat. and young, 1932, № 7; G and n about d m a n d. and l u rk е е а, акушерские, M.-L., 1929; Gruzdev V., A brief essay of the objects in Russia, Shuri. Akush. and wives. B - it, 1906, No. 5-6; Commission report, selected Akush.-Gynech. Obda to address the issue of the organization of obstetric assistance in Moscow, M., 1902; Kolossov M., objectsmate in Moscow. lips.; Levi M., objectiveness in the system of protecting motherhood and infancy, M.-L., 1929; Materials on the organization of public WARCH. assistance to the population of Minsk, lips., Vol. 2, 1905; Popova B., Governing in the cities of Mosk. Region, Mosk. honey. g., 1930, №u; Rhine G., Relativeness in Russia, SPb, 1906; Selitsky., Past and the future of the Moscow Occaper In-Tament is it in the history of objects in Russia, J. on the study. wounds childish ABS., T. ІX, 1929; Proceedings I, II, III and IV Congresses on the OKR. mat. and young, M., 1920, 1923 and 25, Moscow-Leningrad, 1929. See also lit. to art. Maternity hospital. V. Leboaeva.